Open Access Open Badges Research

Cost of illness and economic burden of chronic lymphocytic leukemia

Carl Rudolf Blankart1*, Taika Koch1, Roland Linder2, Frank Verheyen2, Jonas Schreyögg1 and Tom Stargardt1

Author Affiliations

1 Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, D-20354, Hamburg, Germany

2 WINEG—Scientific Institute of the Techniker Krankenkasse (TK) for Benefit and Efficiency in Health Care, Bramfelder Straße 140, D-22305, Hamburg, Germany

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Orphanet Journal of Rare Diseases 2013, 8:32  doi:10.1186/1750-1172-8-32

Published: 20 February 2013



Chronic lymphocytic leukemia (CLL) is a slowly progressing but fatal disease that imposes a high economic burden on sickness funds and society. The objective of this study was to analyze and compare the direct and indirect costs of CLL in Germany from the perspective of the sickness funds and society and analyze the burden of the disease.


Using a database of 7.6 million enrolled individuals, we identified 4198 CLL patients in 2007 and 2008. The costs attributable to CLL were estimated using a case–control design with a randomly selected control group of 150 individuals per combination of age and sex. We used the bootstrap approach to estimate uncertainties in costs estimated. We employed generalized estimating equation regression models and count data models to test for differences in costs and healthcare utilization.


The cost attributable to CLL for each prevalent case amounts to €4946 from the payer’s perspective and €7910 from a societal perspective. Inpatient hospital stays and pharmaceuticals are the main cost drivers of the disease. The economic burden of disease in Germany was estimated to be approximately €201 million per year for the sickness funds and €322 million for society.


Compared with common diseases, such as diabetes or COPD, the economic burden of CLL is considerably lower. However, the cost of treatment per case is about twice as high as the cost per case for these common diseases, even though treatment is only performed in the later stages of CLL. With new healthcare technologies, the aging population, and the increasing incidence of the disease, it is likely that the economic burden of the disease will continue to grow.

CLL; Routine data; Administrative data; Economic evaluation; Case–control design; Elixhauser comorbidity groups